What did we really expect from deinstitutionalization?

Abstract

Long-term, severely disabled psychiatric patients are almost by definition a marginal population. Yet the expectations of deinstitutionalization are often expressed in such terms as "helping them become a part of the mainstream of our society" and "normalization." Although only a minority of long-term patients can realize these expectations, the programs that receive the most attention are those geared to the higher-functioning minority. When scrutinized, proposed "solutions" to the problem of deinstitutionalization are found to be simplistic and unrealistic. Deinstitutionalization will have accomplished a tremendous amount if the mentally ill can live lives of dignity and a reasonable amount of comfort in the community, a good that will require increased investment of both effort and funds in their living arrangements. The private sector, given sufficient financial incentives and proper supervision and support, can provide quality services to chronic patients on a large scale.